This document discusses vitamin K deficiency. It notes that vitamin K is required for the post-translational carboxylation of coagulation factors and other proteins. Vitamin K deficiency can cause hemorrhage and is seen in neonates, people with small bowel diseases or resections, and those on long-term antibiotic therapy. Prolonged prothrombin time indicates deficiency, which is treated with vitamin K supplementation.
Vitamin a presentation, Vitamin A Deficiency, Vitamin A toxicityDhruvendra Pandey
This presentation contains Importance of vitamin A, Sources of Vitamin A, Absorption,Transport and Excretion of Vitamin A, Vitamin A Deficiency, Vitamin A Toxicity, Required dose of Vitamin A, Nutrition, Nutrition deficiency
Vitamin a presentation, Vitamin A Deficiency, Vitamin A toxicityDhruvendra Pandey
This presentation contains Importance of vitamin A, Sources of Vitamin A, Absorption,Transport and Excretion of Vitamin A, Vitamin A Deficiency, Vitamin A Toxicity, Required dose of Vitamin A, Nutrition, Nutrition deficiency
Describes about the importance of vitamins in our daily activities , classification of vitamins,various sources of vitamins and also about the problems which occurs due to the deficiency of vitamins.
Vitamin C is a water soluble vitamin and thus is not stored in the body . It is potent antioxidant and in this covid-19 arena ,there is lot of emphasis of its role in enhancing immunity. it is required daily in 40-80 mgm. This requirement can be easily fulfilled by eating food which are the rich sources of this vitamin.Hope this presentation will clear lots of myths which are prevalent like taking tablet 500-1000mgm daily
Chemistry of Vitamin E, Biochemical role of Vitamin E, Recommended dietary Allowances, Dietary sources of Vitamin E, Deficiency symptoms of vitamin E, Hypervitaminosis of vitamin E, Toxicity of Vitamin E,
Metabolism of zinc and its clinical significancerohini sane
A comprehensive presentation on Metabolism of Zinc and its clinical significance for MBBS,BDS,B.Tech,B.Pharma and Biotechnology students for self-study.
vitamins in chronic kidney disease and hemodialysis patientsPediatric Nephrology
Vitamins are organic substances that cannot be synthesized by the
human body
Their functions are essential for normal human metabolism
In contrast to well-defined standards for healthy children/To date, there have been no randomized controlled trials examining the intake and/or needs of vitamins and trace elements in pediatric (CKD) or ESRD
Natural dietary sources of water-soluble vitamins and key trace elements are found in foods such as fruits, legumes, red meat, and dairy, all of which may be limited in the ESRD population on dialysis because of high potassium and phosphorus contents
Describes about the importance of vitamins in our daily activities , classification of vitamins,various sources of vitamins and also about the problems which occurs due to the deficiency of vitamins.
Vitamin C is a water soluble vitamin and thus is not stored in the body . It is potent antioxidant and in this covid-19 arena ,there is lot of emphasis of its role in enhancing immunity. it is required daily in 40-80 mgm. This requirement can be easily fulfilled by eating food which are the rich sources of this vitamin.Hope this presentation will clear lots of myths which are prevalent like taking tablet 500-1000mgm daily
Chemistry of Vitamin E, Biochemical role of Vitamin E, Recommended dietary Allowances, Dietary sources of Vitamin E, Deficiency symptoms of vitamin E, Hypervitaminosis of vitamin E, Toxicity of Vitamin E,
Metabolism of zinc and its clinical significancerohini sane
A comprehensive presentation on Metabolism of Zinc and its clinical significance for MBBS,BDS,B.Tech,B.Pharma and Biotechnology students for self-study.
vitamins in chronic kidney disease and hemodialysis patientsPediatric Nephrology
Vitamins are organic substances that cannot be synthesized by the
human body
Their functions are essential for normal human metabolism
In contrast to well-defined standards for healthy children/To date, there have been no randomized controlled trials examining the intake and/or needs of vitamins and trace elements in pediatric (CKD) or ESRD
Natural dietary sources of water-soluble vitamins and key trace elements are found in foods such as fruits, legumes, red meat, and dairy, all of which may be limited in the ESRD population on dialysis because of high potassium and phosphorus contents
Fat-soluble Vitamin E & K for dental studentsDeepakAravind8
Fat-soluble vitamins are absorbed through the intestinal tract with the help of lipids Fat-soluble vitamins are absorbed through the intestinal tract with the help of lipids , dental seminar,
Exercise Testing in Cardiology : Dr. Akif Baigakifab93
The testing modality and protocol should be selected in accordance with the patient’s estimated functional capacity based on age, estimated physical fitness from the patient’s history, and underlying disease
Several exercise test protocols are available for both treadmill and stationary cycle ergometers
Patients who have low estimated fitness levels or are deemed to be at higher risk because of underlying disease (e.g., recent MI, heart failure) should be tested with a less aggressive exercise protocol
Treadmill and cycle ergometers may use stepped or continuous ramp protocols
Work rate increments (stages) during stepped protocols can vary from 1 to 2.5 METs
Ramp protocols are designed with stages that are no longer than 1 minute and for the patient to attain peak effort within 8 to 12 minutes
The natriuretic peptide system works antagonistically to the RAAS and has favorable effects on the pathogenesis of heart failure
Natriuretic peptides are broken down by an enzyme called neprilysin
Neprilysin is also responsible for the breakdown of other substances, including bradykinin and angiotensin II
Sacubitril/valsartan is a combination product
Sacubitril is a pro-drug that, upon activation, acts as a neprilysin inhibitor
It works by blocking the action of neprilysin, thus preventing the breakdown of natriuretic peptides
This leads to a prolonged duration of the favorable effects of these peptides
Coronary heart disease (CHD) remains a leading cause of death worldwide, accounting for 16% of total deaths globally .
Atherosclerosis plays a central role, with early fatty streaks progressing to late complex atheromas
Vascular calcification, the pathogenic and process of ectopic bone production, specifically was shown to strongly correlate with degree of atherosclerosis (both calcified and noncalcified)
Vascular calcification was shown independently to predict cardiovascular morbidity and mortality
These associations, combined with the radio-opaque appearance of calcium hydroxyappatite on CT images, have led to extensive investigation of the quantification, or scoring, of coronary artery calcium (CAC).
CAC scoring has emerged as a widely available and powerful tool for stratifying cardiovascular risk, predicting patient outcomes, and guiding preventive therapy
A coronary bifurcation consists of a flow divider (carina) and three vessel segments:
The proximal main vessel (PMV)
The distal main vessel (DMV) and
The side branch (SB).
A bifurcation lesion is a major epicardial coronary artery stenosis next to and/or including the ostium of a significant side branch
A significant SB is a branch whose severe narrowing or acute occlusion before or during intervention can cause considerable ischemia or a new infarction area that will worsen the clinical course of a particular patient.
Other important elements to consider that are not inherent in the bifurcation classifications include:
Extent of disease on the SB (limited to the ostium or involving the vessel beyond the ostium)
Its size (over 2.5mm in reference diameter)
Bifurcation angle, and
Disease distribution
Left ventricular (LV) dysfunction remains one of the
best prognostic determinants of survival in patients
with coronary artery disease (CAD)
⚫ It was originally thought that dysfunctional
myocardium after an infarction was irreversibly
damaged
⚫ However, it was later recognized that some of the
involved tissue remained viable and contractility may
be restored with revascularization
HCM is a common genetic heart disease reported in populations globally
Inherited in an autosomal dominant pattern
The distribution of HCM is equal by sex, although women are diagnosed less commonly than men
The prevalence of unexplained asymptomatic hypertrophy in young adults has been reported to range from 1:200 to 1:500
Tetralogy of Fallot (TOF) is a congenital heart defect, which has four anatomical components:
Anterior malalignment ventricular septal defect (VSD)
Aortic override over the muscular septum
Variable degrees of subvalvar, valvar, and supravalvar pulmonary stenosis
Right ventricular (RV) infundibular narrowing and RV hypertrophy
Ventricular septal defects occur either as an isolated defect or as a component of a more complex lesion
It occurs in 50 percent of all children with CHD and in 20 to 30 percent as an isolated lesion
Most common congenital cardiac anomaly in children
Second most common congenital abnormality in adults, second only to bicuspid aortic valves
They are more common in premature infants and those born with low weight
VSDs are slightly more common in females (56%)
Patients with peripheral artery disease who have undergone lower-extremity revascularization are at high risk for major adverse limb and cardiovascular events
The efficacy and safety of rivaroxaban in this context are uncertain
Most common cyanotic heart defect seen in children beyond infancy, accounting for a third of all congenital heart disease (CHD) in this age group
Tetralogy of Fallot (TOF) is a congenital heart defect, which has four anatomical components:
Anterior malalignment ventricular septal defect (VSD)
Aortic override over the muscular septum
Variable degrees of subvalvar, valvar, and supravalvar pulmonary stenosis
Right ventricular (RV) infundibular narrowing and RV hypertrophy
Bentracimab (also known as PB2452) is a neutralizing recombinant human immunoglobulin G1 monoclonal antibody antigen-binding fragment that binds ticagrelor and its major active circulating metabolite with high affinity and specificity
Chlorthalidone for hypertension in advanced ckdakifab93
Chlorthalidone, a thiazide-like diuretic, reduces cardiovascular morbidity, such as the incidence of stroke and heart failure, and cardiovascular mortality
However, its efficacy and safety among patients with advanced chronic kidney disease remain poorly understood
An acute illness caused by an autoimmune response to infection with group A Streptococcus, leading to a range of possible symptoms and signs affecting any or all of heart, joints, brain, skin and subcutaneous tissues
Amyloidosis is a group of protein-folding disorders in which >1 organ is infiltrated by proteinaceous deposits known as amyloid. Amyloid involvement of the heart (cardiac amyloidosis) carries the worst prognosis of any involved organ, and light-chain (AL) amyloidosis is the most serious form of the disease
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
2. What type of Anemia is seen in Vitamin B6 deficiency
??
3. Microcytic hypochromic anemia
Vitamin B6 is involved in 1st step of heme synthesis
(Aminolevulinate synthase)
Vitamin B6 is also required for conversion of
Homocysteine to Cystathione.
4. Burning feet syndrome is caused by which Vitamin
deficiency ??
6. Higher intake of which vitamin is associated with
renal stones ??
7. Vitamin C
>2gm/day
Vitamin C is metabolised to Oxalate and over intake can
precipitate Renal stones
Formation of renal stones have been seen only if there is
Primary renal disorder.
Can produce Iron overload due to increase Iron absorption
24. Ophthalmoplegia
Horizontal nystagmus
Cerebellar ataxia
Plus memory loss or confabulations : Korsakoff’s
Psychosis
25. Pellagra is caused by ??
What is Hartnup disease ??
Which Anti-TB drug can precipitate Pellagra ??
4 D’s of Pellagra ??
26. Niacin deficiency
Hartnup disease is a congenital defect of Intestinal and
kidney absorption of Tryptophan
Isoniazid is a structural analogue of Niacin
4 D’s of Pellagra : Diarrhoe + Dementia + Dermatitis +
Death
Vitamin B6 and Riboflavin helps in conversion of
Tryptophan to Niacin
27. High output cardiac failure is caused due to which
Vitamin deficiency ??
28. Thiamine
Wet beri beri
Presents with Cardiac manifestations : High output
cardiac failure, Cardiomegaly, Tachycardia
Dry Beri Beri
Presents with Peripheral neuropathy.
30. Transketolase activity measured before and after
administering Thiamine Pyrophosphate
>25% increase in activity is suggestive of Thiamine
Deficiency.
31. 42-year-old woman
20-year history of Crohn's disease
presents with a complaint of low energy levels and hair loss.
Her Crohn's disease is moderately well controlled, with episodic
diarrhoea and abdominal pain, and has not required intestinal
resection.
The patient says that she does not feel like she is having a 'flare' of her
Crohn's disease, and there are no rashes or other symptoms.
On physical examination, her hair is mildly thin, stomatitis is noted,
but the physical examination is otherwise normal.
32. An 8-year-old boy from an underdeveloped rural community is seen by a
health practitioner.
He is noted to be below the fifth percentile for height, and has been doing
poorly in school.
On nutritional assessment the boy's mother reports that his diet consists
mainly of locally produced grains and vegetables that are not fortified, and that
meats are rarely available.
The mother also reports that he does not have much energy, but there are no
other specific complaints and physical examination is unremarkable.
Review of the boy's growth chart shows that height had been stable at the
thirtieth percentile until his last visit at the age of 4 years old.
34. 10-40% is absorbed from small intestine.
Direct relationship with protein metabolism.
Absorption is inhibited by Phytates, fibres as well as
dietary iron.
A RCT showed that standard iron supplements doesn’t
interfere with Zinc absorption.
35. 0.5-1 mg/day is excreted in stools daily.
Serum Zinc concentration = 70-120mcg/dl
60% loosely bound to albumin
30% tightly bound to macroglobulin.
Primary store : Liver and Kidney
Mostly Intracellular bind to Metalloproteinases.
37. Activates many enzyme system
Carbonic Anhydrases, Dehydrogenases, Alkaline
phosphatases and Carboxypeptidases.
Plays a role in growth, Tissue repair, wound healing
and synthesis of Testicular hormone.
38. Impaired phagocytic function
Lymphocyte depletion
Decreased immunoglobulin production
Reduction in the T4+/T8+ ratio
Decreased interleukin (IL)-2 production
39. Inhibits secretory effect of Cholera toxin and Heat
labile enterotoxins
Direct inhibitory effect on Enteropathogenic E-coli
40. Meat
Milk
Sea foods
Legumes
Nuts
Cereals
Less available for absorption
41. Inadequate intake
Breastfeeding : Breast milk has low zinc content.
Crohn’s Disease : Decreased absorption
Cystic fibrosis
Sickle cell anemia
Due to renal tubular damage leading to increased urinary
excretion.
42. Drugs
Penicillamine , Ethambutol, Thiazide and certain
antibiotics.
Liver diseases
Due to Hypoalbuminemia
43. Increased risk of infection.
Stomatitis : Non specific
Fatigue
GI Symptoms : Nausea, vomitings, diarrhoea
Short stature
44. Bone fractures due to osteopenia
Impaired glucose tolerance
Hypogonadism
Alopecia
Hypogeusia
45. Autosomal Recessive disease
Partial defect in Zinc absorption.
Due to mutation of SLC39A4 on chromosome 8.
Diarrhoea, Alopecia, Dermatitis, depression , irritability.
Growth retardation and delayed sexual maturation.
Frequent infections.
Characteristic erythematous vesico-bullous dermatitis.
46.
47. Serum Zinc levels : <60mcg/dl
May be low in hypoalbuminemia
Serum Zinc levels is very insensitive, as it can be
normal in patients with mild Zinc Deficiency
Albumin level as poor correlation with Zinc levels,
so if there is suspicion of Zinc deficiency and if Zinc
levels are low , patient should be treated despite of
Serum albumin levels.
48. Zinc level in Lymphocyte or neutrophils is more
sensitive.
Zinc level in either lymphocytes (<50 mcg/1010 cells)
Granulocytes (<42 mcg/1010 cells)
Depressed serum alkaline phosphatase
49. Vitamin D or A deficiency
Hypothyroidism
Depression
Vitamin B12 or folate deficiency
Iron deficiency
50. 1-2mg/kg/day of elemental Zinc.
3mg/kg/day for Acrodermatitis Enteropathica.
Usual supplementation dose is : 20-40mg/day
Higher doses may be required in severe deficiency due
to increased GI loss or malabsorption.
51. Usually treatment is given for 3-6 months.
Acrodermatitis enteropathica
Requires life long supplementation
Stoppage has been associated with recurrence of disease
As skin manifestations are due to enzyme deficiency,
topical Zinc has no role.
Monitor serum copper levels in long term therapy as
Zinc competes with copper for absorption.
52. WHO recommends zinc supplementation for infants
and children with acute diarrhea in resource-limited
countries .
The supplements are given at a dose of 20 mg/day for
children
10 mg/day for infants younger than 6 months old, for
10 to 14 days.
53. Intake of 10 times the normal supplementation
doesn’t produce any symptoms.
Chronic ingestion of high dose Zinc can cause
Copper deficiency.
Acute ingestion of 1-2 gm Zinc sulphate can cause
nausea, vomiting, GI erosions and renal tubular
necrosis.
54. Prophylactic supplementation of Zinc to < 5years of
age children has known to decrease chances of
Pneumonia and diarrhoea when compared to placebo
in many trials.
57. Required for post translation carboxylation of :
Factor 2,7,9,10
Protein C and S
Osteocalcin in bone
Matrix GLA protein of
Vascular smooth muscle.
Importance is not known
59. Hemorrhage
Neonates are more prone due to decreased fat stores ,
immaturity of Liver, poor placental transport and
decrease content in breast milk.
Intracranial, skin and GI bleeding can occur 1-7days
after birth.
Thus Vitamin K 0.5-1 mg is given I.M at birth
60. Vitamin K deficiency can be present in small bowel
disease, Small bowel resection and biliary obstruction.
Prolonged antibiotic therapy can decrease GI bacteria
and cause decrease menaquinone levels.
Anti-obesity drug Orlistat can cause Vitamin K
malabsorption.
61. Causes prolonged Prothrombin time
Treated with 10mg Vitamin K .
In chronic deficiency 1-2mg/day oral intake or 1-2mg
i.m weekly.